Introduction. - The health crisis linked to the COVID-19 epidemic has required lockdown measures in France and changes in practices in dialysis centers. The objective was to assess the depressive and anxiety symptoms during lockdown in hemodialysis patients and their caregivers. Methods. - We sent, during lockdown period, between April and May 2020, self-questionnaires to voluntary subjects (patients and caregivers), treated by hemodialysis or who worked in hemodialysis in one of the 14 participating centers in France. We analyzed their perception of dialysis sessions (beneficial or worrying), their stress level (VAS rated from 0 to 10), their anxiety and depressive symptoms (Hospital anxiety and depression scale). Factors associated with stress, anxiety and depression were analyzed with multiple linear regression models. Results. - 669 patients and 325 caregivers agreed to participate. 70 % of participants found it beneficial to come to dialysis during confinement. The proportions of subjects with a stress level >= 6 linked to the epidemic, confinement, fear of contracting COVID-19 and fear of infecting a loved one were respectively 23.9%, 26.2%, 33.4% and 42%. 39.2% presented with certain (13.7%) or doubtful (19.2%) anxious symptoms. 21.2% presented a certain (7.9%) or doubtful (13.3%) depressive symptomatology. Age, gender, history of psychological disorders and perception of dialysis sessions were associated with levels of stress, anxiety and depression. Conclusion. - During the lockdown period, in France, the majority of hemodialysis patients and caregivers found it beneficial to come to dialysis. One in three subjects had anxiety symptoms and one in five subjects had depressive symptoms. (C) 2021 Published by Elsevier Masson SAS on behalf of Societe francophone de nephrologie, dialyse et transplantation.

Early information about the kidney transplant is recommended to begin quickly the process of registration on the kidney transplantation waiting list, even for the patients not dialyzed at stage V of the renal insufficiency. It is a strategic choice for the patient care. From the arrival of all the patients in our center of dialysis, a systematic evaluation of the access to the kidney transplant waiting list is organized thanks to a clinical pathway. The impact of this new organization was estimated at 18 months with regard to the information about the kidney transplant transmitted to the patient, of the time required for the assessment of pre-kidney transplant evaluation, and of putting in contraindication. On 78 incident patients, 64 received the information concerning the kidney transplant. After 18 months, 50 clinical pathways are finalized at the time of the analysis among which 25 with a period lower than 6 days and 25 with a median of 169 days. A significant difference of age exists between both groups. The main causes of definitive medical contraindications were estimated. Twenty-two percent of the clinical pathway finalized is awaiting lifting of temporary contraindication. The management of the patient is improved, due to motivation of all the medical teams and a considerable work of coordination between the secretarial department and the department of transplantation in teaching hospital. (C) 2016 Association Societe de nephrologie. Published by Elsevier Masson SAS. All rights reserved.

In order to rationalize the cost of care for dialysis patients in Centre, regulatory authorities urge establishments to favor the orientation of the patients in Medical Dialysis Unit where the medical presence is not permanent. This involves clinical skills for nurses in the conduct of the dialysis session. Faced with this changing work patterns, we present two security tools of the dialysis session. The first is a "check-list", simple, quick and easy to use, it enables secure connection phase of the patient. It was quickly integrated practice of all professionals. The second tool developed is a combination of indicators "DEAUP" for Pain, Purification, Blood access, Ultrafiltration and other Problems for assessing the quality of the course of the dialysis session. The aim is to reduce the occurrence of adverse events, the DEAUP rating certain criteria depending on the occurrence of incidents, from 0 to 2, 2 corresponding to the appearance of an incident having required the call of the doctor and constitute a precious tool of evaluation of the session for all the professionals. All nurses have joined the practice of evaluation, 98% of the realized sessions are informed and quoted; 8.4% of sessions required call nephrologists before or at the connection. The evaluation at the end of dialysis session found 15% of the sessions listed 2. Calls have resulted in an adjustment to the prescription of the sessions. (C) 2013 Association Societe de nephrologie. Published by Elsevier Masson SAS. All rights reserved.

For 25 years, our institution specialising in the treatment of all stages chronic renal failure patients, treat 25% of its patients by peritoneal dialysis (PD), this allowing us to achieve quantitative regional goals. Peritonitis is one of the most common complications of PD. To improve the quality and safety of PD home treatment, our institution has since 2006 initiated a mortality and morbidity review in PD (MMR PD). We suggest to report on the benefits analysis observed in our practice after 3 years. Our institution MMR PD is part of our professional practices evaluation policy. The systemic analysis conducted at the MMR PD takes into account all interacting factors (organisational, technical and human) and go beyond the individual dimension. Its working rules and organisation are described in a written procedure and distributed to all involved professionals. This document specifies the MMR PD responsibility: PD referral physician, frequency of meetings: quarterly, the participating doctors and health executives, terms of case selection, conducting, monitoring improvement actions and their impacts. Over 3 years, 109 cases were analysed including 42 MMR PD for peritonitis. The research of problems encountered during the treatment of patients on PD or the answer to the question ‘how did this happen?’ conducted to the following conclusion: lack of traceability and analysis of systematic treatment problems encountered. This conclusion has helped to re-write and validate by involved professionals the peritonitis management protocol. Therefore the necessary element collection for root cause analysis has been implemented. Three large groups of peritonitis were quickly identified (95% of cases): hand carried peritonitis digestive bacteria peritonitis recurring peritonitis For each type of peritonitis, the causes search, the recovery analysis and the implementation of improvement actions have been completed: For hand carried peritonitis Creation a questionnaire to systematically evaluate the quality of patient handling Reassessment and early re-education of the patient Changing the autonomy treatment offer for the elderly For digestive bacteria peritonitis (80% are identify 48 h after diarrhoea, digestive disorders, impaction): Preventive treatment: patient education in disorders identification and eviction, antibiotic prophylaxis to be discussed. urative treatment by expanding the antibiotic spectrum for any peritonitis preceded by digestive disorders For recurring peritonitis, after bibliography review, the most probable hypothesis is the biofilm infection around the dialysis catheter: it was decided to complete the treatment of peritonitis with intra-catheter TAUROLIDINE stasis. The MMR PD has significantly improved our PD home treatment: the peritonitis occurrence in our institution decreased from 1/26 months in 2007 to 1/39.75 months in 2009. Moreover, our results are well above the national average, in 2007 the peritonitis occurrence in France was of 1/33 months (source RDPLF). The MMR PD led to optimise an organisation that we thought good already, to identify during dialysis (repetitive activity) meaningful recurrences and to enhance the quality and safety of home treatment PD. The contribution of independent nurses providing the home PD exchanges is being considered. Depuis 25 ans, notre établissement, spécialisé dans la prise en charge des patients insuffisants rénaux chroniques à tous les stades, traite 25% de ses patients par dialyse péritonéale (DP), ceci nous permettant d'atteindre les objectifs quantitatifs régionaux. L'infection péritonéale (IP) en DP est la complication la plus fréquente de cette technique. Afin de mener des actions d'amélioration de la qualité et de la sécurité des soins en DP à domicile, notre établissement, a instauré depuis 2006 une revue de mortalité et de morbidité en DP (RMM DP). Nous proposons de rapporter l'analyse des bénéfices observés sur nos pratiques après 3 ans. La RMM DP de notre établissement s'inscrit dans la politique d'évaluation des pratiques professionnelles. L'analyse systémique menée lors de la RMM DP prend en compte tous les éléments (organisationnels, techniques et humains) en interaction et permet de dépasser la dimension individuelle. Ses règles de fonctionnement et son organisation sont décrites dans une procédure écrite et diffusée à tous les professionnels concernés. Ce document précise le responsable de la RMM DP: médecin référent DP, la périodicité des réunions: trimestrielle, les participants: médecins et cadres de santé, les modalités de sélection des cas, le déroulement, le suivi des actions d'amélioration et de leurs impacts. Sur 3 ans, 109 dossiers ont été analysé en RMM DP dont 42 pour des infections péritonéales. La recherche des problèmes rencontrés au cours de la prise en charge des patient en DP soit la réponse à la question « comment est-ce arrivé? » a abouti au constat suivant: insuffisance de traçabilité et d'analyse systématique des problèmes de soins rencontrés. Ce constat a permis la ré-écriture et la validation par les professionnels impliqués du protocole de prise en charge des péritonites. Ainsi la collecte de tous les éléments nécessaires à l'analyse des causes a été mise en œuvre. 3 grands groupes d'IP ont été rapidement identifiés (95% des cas): IP manuportées IP à germes digestifs IP récidivantes. Pour chaque type d'IP, la recherche des causes, l'analyse de la récupération et la mise en œuvre d'actions d'amélioration ont été réalisées: Pour les IP manuportées: Création d'un questionnaire d'évaluation systématique de la qualité de la manipulation par le patient Réévaluation et rééducation précoces du patient Modification de l'offre soins en autonomie pour le sujet âgé Pour les IP à germes digestifs, dont 80% se déclarent 48h suivant des diarrhées, des troubles digestifs, fécalome: Traitement préventif: éducation du patient au repérage et à l'éviction des ces troubles, antibioprophylaxie à discuter. Traitement curatif par élargissement du spectre d'antibiothérapie pour toute IP précédée de troubles digestifs Pour les IP récidivantes, après analyse bibliographiques, l'hypothèse d'une infection du Biofilm a été retenue: il a été décidé de compléter le traitement de l'IP par une stase de taurolidine intra-cathéter. La RMM DP a permis une amélioration significative de notre prise en charge en DP à domicile: l'incidence d'IP dans notre établissement est passée de 1/26 mois en 2007 à 1/39.75 mois en 2009. De plus, nos résultats sont bien au-delà de la moyenne nationale, en 2007 l'incidence d'IP en France est de 1/33 mois (source RDPLF). La RMM DP a conduit à optimiser une organisation que nous pensions exemplaire, de repérer en dialyse (activité répétitive) des récurrences pouvant être signifiantes et d'améliorer la qualité et la sécurité des soins en DP à domicile. La participation des infirmiers libéraux, assurant les échanges de DP au domicile est actuellement envisagée.